Melanoom van de huid: excisiebeleid en pathologieverslaglegging in de regio van het Integraal Kankercentrum Zuid bij iets meer dan de helft van de patiënten volgens de richtlijn

To determine the extent to which the guidelines for cutaneous melanoma had been implemented in the diagnostic and treatment approach of general hospitals.

Design

Retrospective, descriptive.

Method

Patients were selected via the cancer registration system of the ‘Integraal Kankercentrum Zuid’ (Integral Cancer Centre South, the Netherlands). They were submitted through the pathology laboratory by 1 of the 16 general hospitals in the region. Data was collected from the pathology (PA) reports of the 573 patients for whom a cutaneous melanoma was diagnosed in 1988, 1993 and 1997. The treatment policy and the PA reports were compared with the recommendations in the guidelines concerned and the revised versions of these published in 1985, 1990 and 1997. The patients studied were 212 men (37) and 361 women (63) with an average age of 51 years (range 13-96).

Results

A diagnostic excision was performed in 485/573 patients (85). Invasiveness was assessed in 99 of the preparations; in 14 a melanoma was encountered in situ. Invasive melanomas were less often seen in the head and neck region than on the trunk or limb. Thickness of the tumour was not determined in 8 of all 493 invasive tumours and in 19 the pathology report did not state whether the diagnostic biopsy was performed radically. In accordance with the guidelines, diagnostic excision biopsy was first performed in 59 of patients with a subsequent re-excision if necessary; 77 of the PA reports satisfied the fundamental recommendations from the guidelines. For 55 of the patients the diagnostic and therapeutic procedures as well as the pathology report were completed in accordance with the guideline recommendations. Modest improvement occurred over time.

Conclusion

The excision and re-excision policies as well as the pathology report writing concurred with the recommendations in the consensus for cutaneous melanoma in slightly more than half of the patients who were diagnosed within the IKZ region in the years 1988, 1993 and 1997.